Citation NR: 9710328
Decision Date: 03/31/97 Archive Date: 04/04/97
DOCKET NO. 94-29 586 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Louisville,
Kentucky
THE ISSUE
Entitlement to service connection for the cause of the
veteranís death.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
Laura M. Helinski, Associate Counsel
INTRODUCTION
The veteran had active service from June 1942 to October
1945, and from November 1947 to July 1953, including a period
as a prisoner of war for four days, dates unavailable.
This matter comes before the Board of Veteransí Appeals (BVA
or Board) on appeal from a September 1993 rating decision of
the Department of Veterans Affairs (VA) Regional Office (RO)
in Louisville, Kentucky, which denied the benefit sought on
appeal. The appellant appealed that decision to the BVA.
REMAND
According to the veteranís death certificate, he died on July
[redacted], 1993, due to an immediate cause of atherosclerotic
cardiovascular disease, due to or as a consequence of
diabetes mellitus. The appellant, the veteranís wife,
essentially contends that the veteranís demise was related to
his time in service. Specifically, she asserts that for two
years prior to the veteranís death, he attended ex-prisoner
of war group sessions, and that when he would return from
these sessions he always appeared depressed. The appellant
contends that these sessions made his high blood pressure
hard to control, and that this, along with the veteranís
service-connected post-traumatic stress disorder (PTSD),
contributed to his death. The Board notes that during the
veteranís lifetime, service connection was in effect for
PTSD, evaluated as 50 percent disabling; a shell fragment
wound of the left foot and left knee region, evaluated as
noncompensable; and, an injury to the coccyx, evaluated as
noncompensable.
A July 1993 VA medical report reveals that the veteran was
diagnosed with congestive heart failure. Following the
veteranís death, a January 1994 private statement by [redacted], R.N., indicated that she knew the veteran for 18
years, and that for the last 10 years of his life, he had
talked more frequently about his days in service, which
appeared to depress him. Ms. [redacted] stated that the veteranís
blood pressure seemed to increase with his stress and mental
anguish associated with remembering the past. This was
particularly apparent after the veteran would return from
sessions at VA clinics for his PTSD. In Ms. [redacted]ís opinion
as a registered nurse, stress could lead to hypertension,
which, in turn, could lead to cardiovascular disease, which
suggested that the veteranís death should be service-
connected.
In March 1996, the appellantís representative submitted a May
1995 general medical synopsis by Lawrence R. Moss, M.D.
regarding the relationship between hypertension and PTSD.
This synopsis suggested that stress could lead to
hypertension, but it did not specifically refer to the
veteran or his medical condition.
In September 1996, a VA physician provided a medical
evaluation of the veteran, based on his review of the
veteranís entire C-file, and other medical records at the VA
medical center in Lexington, Kentucky, where the veteran had
received treatment. In the VA physicianís opinion, the
veteran had developed significant cardiovascular disease, and
died of a coronary occlusion. However, he indicated that
there was no evidence that the veteran had cardiovascular
disease in service, or within the first post-service year.
The physician noted the absence of the veteranís service
medical records; however, he also indicated that at the time
the veteran had been seen at the VA medical center in
Lexington in the 1980ís, there was no evidence that he had a
cardiovascular condition. The physician further indicated
that there was no evidence that the veteran ever had
beriberi, or that beriberi may have been related to the
veteranís heart disease. In summary, the physician found no
basis upon which to relate the veteranís death to his time in
service.
In September 1996, Ms. [redacted], R.N., submitted another
statement indicating that the veteran used to return from
ďround tableĒ discussions at a VA hospital, where he was
being treated for PTSD, and that he would often cry after
these sessions, due to his memories of active service. She
also indicated that he would have flashbacks at night, and
wake up crying and shaking.
In light of the foregoing, the Board finds that further
development is necessary for clarification. The Board notes
that Ms. [redacted]ís statements are not accompanied by any
treatment records or other supporting documentation to assist
the Board in weighing the credibility of her opinion.
Additionally, the September 1996 VA medical opinion fails to
address the appellantís contention that the veteranís PTSD
contributed to his fatal atherosclerotic cardiovascular
disease.
Therefore, to ensure that the VA has fully met its duty to
assist the appellant in developing the facts pertinent to her
claim, the case is REMANDED to the RO for the following
development:
1. The RO should contact [redacted],
R.N., and ask that she provide supporting
documentation specific to the veteranís
case regarding the bases for her opinion
relating to the cause of the veteranís
death. Ms. [redacted] should be requested to
provide any relevant treatment records
for the veteran. The RO should obtain
copies of these records, along with any
necessary authorization, and associate
them with the claims file.
2. Thereafter, the claims file should be
referred to a VA cardiovascular
specialist, for an opinion as to whether
any of the veteranís service-connected
disabilities to include PTSD, contributed
substantially or materially to the cause
of the veteranís death, listed on the
death certificate as an immediate cause
of atherosclerotic cardiovascular
disease, due to or as a consequence of
diabetes mellitus, as the appellant
contends. A complete rationale for any
opinion expressed should be provided.
3. When the development requested has
been completed, the case should again be
reviewed by the RO on the basis of the
additional evidence. If the benefits
sought are not granted, the appellant and
her representative should be furnished a
supplemental statement of the case, and
be afforded the appropriate time period
to respond before the record is returned
to the Board for review.
The purpose of this REMAND is to both obtain additional
information and to accord the appellant due process of law.
The Board does not intimate any opinion as to the merits of
the case, either favorable or unfavorable, at this time. The
appellant is free to submit any additional evidence she
desires in connection with her current appeal. No action is
required of the appellant until she is notified.
S. L. KENNEDY
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, ß 6, 108 Stat. 740, 741
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
Under 38 U.S.C.A. ß 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of a
preliminary order and does not constitute a decision of the
Board on the merits of your appeal. 38 C.F.R. ß 20.1100(b)
(1996).
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